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Ling Gan Wu Wei Jiang Xin Tang苓甘五味姜辛湯

Jin Gui Yao Lue, Essentials Prescriptions from the Golden Cabinet.1- Ling gui wu wei gan cao tang2- Ling gan wu wei jiang xin tang3- Ling gan wu wei jiang xin ban xia tang4- Ling gan wu wei jiang xin ban xia xing ren tang5-Ling gan wu wei jiang xin ban xia xing ren da huang tangNote on Xiao Qing Long Tang

Ling Gui Wu Wei Gan Cao TangLing Gan Wu Wei Jiang Xin TangLing Gui Wu Wei Gan Cao Qu Gui Jia Jiang Xin Xia TangLing Gan Wu Wei Jiang Xin Xia Xing TangLing Gan Wu Wei Jiang Xin Xia Xing Da Huang TangFu Ling 12 Fu Ling 12 Fu Ling 12 Fu Ling 12 Fu Ling 12Gan Cao 9 Gan Cao 9 Gan Cao 6 Gan Cao 9 Gan Cao 9Wu Wei Zi 6 Wu Wei Zi 6 Wu Wei Zi 6 Wu Wei Zi 6 Wu Wei Zi 6Gui Zhi 12 Xi Xin 9 Xi Xin 6 Xi Xin 9 Xi Xin 9Gan Jiang 9 Gan Jiang 6 Gan Jiang 9 Gan Jiang 9Ban Xia 6 Ban Xia 9 Ban Xia 9Xing Ren 9 Xing Ren 9Da Huang 9Ling Gan Wu Wei Jiang Xin Xia Tang

Common herbs in these Formulas• All of these Rx’s contain• Fu ling• Gan cao• Wu wei ziModifications: gui zhi, Gan jiang, Xi xin, Ban xia, xing ren and Da huang.

Fu ling (茯苓)• taste and property: Sweet, neutral• channels: Lu, SP, HT and BL• Chinese Herbal Medicine: Materia Medica" by Bensky, Clavey, and Stöger, the actions of Fu Ling (茯苓) include the following:1. Promotes Urination and Leaches Out Dampness: Fu Ling has a diuretic effect and helps to promote urination, thereby leaching out dampness from the body. It is used for conditions characterized by dampness accumulation, such as edema, bloating, and urinary difficulty.2. Strengthens the Spleen and Harmonizes the Middle Jiao: Fu Ling tonifies the Spleen and helps to regulate its functions, promoting healthy digestion and alleviating symptoms of Spleen deficiency, such as fatigue, poor appetite, and loose stools.3. Quiets the Heart and Settles the Spirit: It has a calming effect on the Heart and Shen (spirit), helping to soothe emotional disturbances and alleviate symptoms of restlessness, irritability, and palpitations.4. Eliminates Phlegm and Calms the Spirit: Fu Ling helps to transform phlegm and dampness, particularly when combined with herbs that open the orifices and calm the spirit. It is used for conditions such as phlegm misting the mind, forgetfulness, and insomnia.5. Harmonizes the Stomach and Alleviates Nausea: It helps to regulate the function of the Stomach, alleviate nausea, and harmonize the Middle Jiao. Fu Ling is often included in formulas for digestive disorders, such as gastritis, indigestion, and acid reflux.

Gan CaoTaste and property: sweet, neutral Channels: SP/LU/HT• In "Chinese Herbal Medicine: Materia Medica" by Bensky, Clavey, and Stöger, the actions of Gan Cao (甘草) include the following:1. Tonifies the Spleen and Augments the Qi: Gan Cao is known for its tonifying properties, particularly in strengthening the Spleen and augmenting Qi (vital energy) of the body. It is used for conditions of Spleen deficiency, such as fatigue, weakness, and poor appetite.2. Moistens the Lungs and Stops Cough: It has a moistening effect on the respiratory tract, helping to alleviate symptoms of dry cough, dry throat, and hoarseness. Gan Cao is often used in formulas for treating coughs and respiratory disorders.3. Clears Heat and Detoxifies Fire Poison: Gan Cao has a mild cooling effect and is used to clear heat from the body, particularly in the Upper Jiao (Lungs) and Middle Jiao (Stomach). It is employed in formulas for treating conditions associated with excess heat.4. Moderates Spasms and Alleviates Pain: Gan Cao has muscle-relaxant properties and can be used to relieve spasms and pain, making it suitable for conditions such as abdominal pain and muscle cramps.5. Harmonizes and Moderates the Characteristics of Other Herbs: Gan Cao is often included in herbal formulas to harmonize the actions of other herbs, enhance their effects, and mitigate potential side effects. It helps to balance the properties of a formula.

Wu Wei Zi• Taste and property: Sour, sweet and warm• Channels: Lu, HT and KD• According to "Chinese Herbal Medicine: Materia Medica" by Bensky, Clavey, and Stöger, the actions of Wu Wei Zi (五味子) include the following:1. Astringes Lung Qi: Wu Wei Zi tonifies Lung Qi and helps to consolidate and retain the Lung's vital energy. It is used for chronic cough, wheezing, and asthma due to Lung Qi deficiency.2. Stabilizes the Kidneys and Binds Essence: It tonifies Kidney Qi and helps to preserve Jing (essence). Wu Wei Zi is used for symptoms of Kidney deficiency, such as frequent urination, nocturnal emissions, and low back pain.3. Generates Fluids and Alleviates Thirst: Wu Wei Zi has a moistening effect on the body, helping to generate fluids and alleviate symptoms of dryness, such as dry cough, dry mouth, and thirst.4. Inhibits Sweating and Generates Fluids: It is used to treat spontaneous sweating and night sweats, especially when they are due to Kidney deficiency.5. Calms the Spirit and Quiets the Heart: Wu Wei Zi has a calming and sedative effect on the mind, helping to alleviate symptoms of irritability, palpitations, and insomnia caused by Heart and Liver imbalances.

Xi Xin• Taste: Pungent, spicy• Property: Warm• Channels: LU,SP and KD• In "Chinese Herbal Medicine: Materia Medica" by Bensky, Clavey, and Stöger, the actions of Xi Xin (细辛) include the following:1. Dispels Cold and Warms the Interior: Xi Xin has a strong warming effect on the interior of the body and is used to dispel cold from the body's surface and interior. It is particularly effective for treating cold patterns characterized by cold extremities, aversion to cold, and pain aggravated by cold weather or exposure.2. Opens the Orifices: It has a stimulating effect on the sensory orifices and can help to clear the head and open the nasal passages. Xi Xin is used to treat conditions such as headache, nasal congestion, sinusitis, and dizziness caused by obstruction of the orifices.3. Expels Wind and Dampness: Xi Xin has a dispersing action and can help to expel wind and dampness from the body. It is used for conditions characterized by wind-damp invasion, such as rheumatic pain, arthritis, and joint stiffness.4. Alleviates Pain: Xi Xin promotes the circulation of Qi and Blood and can help to alleviate pain associated with cold stagnation or obstruction of the channels. It is used for conditions such as headache, toothache, and abdominal pain.

Xi Xin is for when the Tai Yin Lung and Tai Yang Surface is frozenTai Yin/Lung/Skin –Tai YangCausing symptoms of Cold Pain, Water Rheum

Gan JiangTaste: Pungent, spicyProperty: HotChannels: SP, ST, LU ,KD• In "Chinese Herbal Medicine: Materia Medica" by Bensky, Clavey, and Stöger, the actions of Gan Jiang (干姜) include the following:1. Warms the Middle Jiao and Dispels Cold: Gan Jiang has a strong warming effect on the Middle Jiao (digestive system) and is used to dispel cold from the Stomach and Spleen. It is particularly effective for treating cold patterns characterized by abdominal pain, diarrhea, vomiting, and poor appetite.2. Warms the Lungs and Stops Cough: It is used to warm the Lungs and transform phlegm, helping to stop coughing and alleviate symptoms of cold-induced coughs, such as wheezing, chest tightness, and copious phlegm.3. Warms the Channels and Stops Pain: Gan Jiang promotes the circulation of Qi and Blood and can be used to alleviate pain associated with cold stagnation in the channels. It is often included in formulas for treating cold-induced pain in the limbs, joints, and abdomen.4. Warms the Kidneys and Disperses Cold: It has a tonifying effect on the Kidneys and can be used to dispel cold from the lower back and abdomen. Gan Jiang is used for treating symptoms of Kidney deficiency, such as cold extremities, weak knees, and low back pain.5. Rescues Devastated Yang: Gan Jiang is considered to have a strong Yang-tonifying effect and can be used to rescue devastated Yang Qi, particularly in cases of collapse due to extreme cold or deficiency.

Propping Rheum is Defined in the Jin Gui Yao Lue as symptoms that include difficult breathing, coughing and inability to lie flat

Rheum, Propping RheumRheum patterns manifest as a pathological overproduction of body fluids. Rheum or Phlegm-RheumThin, watery fluids in the lungs or stomachor discharged from the eyes, nose, ormouth. Always indicates cold.Propping Rheum-Group of symptoms include difficult breathing, coughing and inability to lie flat, patient needs to be propped up.Propping Rheum- collects in the chest and lungs.

Types of RheumDepending on where rheum collects, phlegm- rheum in the broadest sense includes all four kinds of rheum.In Specifics, phlegm-rheum collecting to the intestines and stomachSuspended Rheum under the rib sidesSpillage rheum in the fleshy exteriorPropping rheum in the chest and lungsHowever, the various manifestations of phlegm-rheum cannot always be clearly distinguished since they are often interrelated.Since phlegm-rheum disease is characterized by yang def with yin exuberance, to treat the root generally involves harmonizing with warm-natured medicinals.

Propping Rheum• From the book Extraordinary Views of Abdominal Patterns , Inaba Katsu Bunrei • “Propping Rheum Zhi Yin: 支阴:• refers to water in the region below the heart with cough and copious phlegm, leading to the inability to lie down and swelling( i.e. edema) and distention of the body.• Patient needs to be Propped up

• “Modern scholars translate the pattern of propping-rheum as rheum in the lung and Pericardium”• “From the symptoms, we can assume that the pattern of propping-Rheum is similar to the condition of pulmonary edema and congestive heart failure.• As we know, the ventricles of the heart act as circulation pumps. When the right ventricle fails, the systemic veins become congested, reflected in an increased jugular ventricle pressure, and elevated back pressure causing peripheral edema, ascites, and an enlarged, tender liver. When the left ventricle fails, the pulmonary venous and pulmonary capillary pressure rise. Fluid leaks into the pulmonary interstitium and alveoli, producing pulmonary oedema.• Rheum in the lung specifically indicates a condition where fluid has leaked into the pulmonary interstitium- difficult breathing with coughing of pink foam. Rheum in the PC increased jugular pressure and related to congestive heart failure.• Dr. Mark C. Fishman, Medicine, 1996• ( Cardiologist, Harvard, professor stem cell and regenerative biology)

• Xiao Qing Long Tang (小青龙汤)• also known as Minor Blue-Green Dragon Decoction, It was first recorded in the medical text "Shang Han Lun" (伤寒论), or "Treatise on Cold Damage" by Zhang Zhong Jing during the Eastern Han Dynasty.• Line 35 (JGYL): For coughing with counterflow and propped breathing with an inability to lie flat, Xiao Qing long Tang is indicated.( the rheum collected in the upper body is here contending with pathogenic cold contracted externally)• Ingredients:• Ma huang 9• Gui Zhi 9• Bai Shao 9• Xi xin 9• Gan jiang 9• Zhi gan cao 9• Wu wei zi 9• Ban xia 12

Formula ExplanationXiao Qing Long Tang•XQLT can treat patterns of propping Rheum where external cold evil manifest with coughing when upright Qi is not deficient. If you see a cough with shortness of breath, watery spittle, slippery wet tongue moss and a floating wiry or floating tight pulse, you should consider using this. At the same time, the scattering and emitting strength of this formula is great. It can increase the Lung Qi and diminish the Kidney root. It is the wrong medicine for a deficient person. It can cause reversal cold of the 4 limbs and make the Qi from the lower abdomen surge up into the chest and throat. It can also cause the side effect of creating a feather-warm facial flushing as if drunk. So, as soon as the symptoms stop, do not continue this formula. In one day the disease characteristics change and so the formula should be changed to a Ling Gui formula to warm and transform. Just as the Jin Gui says: “in phlegm fluid illness, one must warmly transform.”

Ling Gui Wu Wei Gan Cao Tang• Original text [Chapter 12.36]: If after taking Xiao Qing Long Tang, there is abundant spittle with a parched mouth. The cun pulse is sunken and the chi pulse is faint, reversal cold of the hands and feet, surging Qi from the lower belly into the chest and throat, painful obstruction in the hands and feet and feather-warm facial flushing as if the person is drunk, and because there is flowing down to the Yin section, the urination is difficult and there is occasional dizziness, Ling Gui Wu Wei Gan Cao Tang is indicated. LING GUI WU WEI GAN CAO TANGFu Ling 4 liang 12 gmGui Zhi 4 liang 12 gmGan Cao 3 liang 9 gmWu Wei Zi ½ sheng 6 gm

Ling gui wu wei gan cao tang• treats surging qi due to yang deficiency and it treats water accumulation. Yang qi has become weak due to an external pattern of xiao Qing long tang. This was a wind strike pattern with damp accumulation in the tai yin lung causing coughing. After treatment there is still a surging qi and it is due to a yang qi weakness. Weak yang floats upwards and causes counter flow qi.

"Surging Qi" (Chinese: 气逆; pinyin: qì nì)• Surging Qi relates to the Chong vessel. The Chong vessel emerges from the lower Jiao. Relying on the kidney vessel it goes up and reaches to chest and throat. When Chong Qi rebels upward, the Qi surges upward from the lower belly to the chest and throat. The face flushes hot as if one is drunk. The reversal Qi rises up and the Yang Qi is not managed. This causes reversal cold of the hands and feet so that there is painful obstruction. When the Chong Qi rebels upward it causes the Qi of the entire body to rebel upward. Below this causes the urination to be difficult while above this causes dizziness. To address this, one must first restrain the Qi and calm surging. It is appropriate to use Cinnamon Twig, Poria, Schisandra, and Licorice Decoction(Ling gui wǔ wèi gān cǎo tāng). Cinnamomi Ramulus(guì zhī)down bears the surging Qi. Poria(fú líng)disinhibits the water Qi. Schisandrae Fructus(wǔ wèi zǐ)restrains rebellious Qi and Glycyrrhizae Radix(gān cǎo)calms the middle Qi. When Cinnamomi Ramulus(guì zhī)and Glycyrrhizae Radix(gān cǎo)are combined, the pungent and sweet transform the Yang and stimulate the heart Yang above. Then the cold water in the lower Jiao is spontaneously warmed and then it cannot rebel upward. The surging Qi is successfully calmed.• From: Ding Gan Ren’s case studies, article in White pine institute by Sharon Weizenbaum.

Ling Gan Wu Wei Jiang Xin Tang (陵赣乌梅姜辛汤)"Poria, Licorice, Schisandra, Ginger, and Asarum Decoction."Original text [12.37]: When the surging Qi has been calmed but coughing and fullness in the chest are aggravated, use Ling Gui Wu Wei Gan Cao Tangwith Gui Zhi removed and Gan Jiang and Xi Xin added to treat coughing and fullnessLing Gan Wu Wei Jiang Xin TangFu Ling 12Gan Cao 9Wu Wei Zi 6Xi Xin 9Gan Jiang 9However, despite the reduction of surging Qi, the symptoms of coughing and chest fullness reappear or continue

Ling Gan Wu Wei Jiang Xin TangFu Ling 12Gan Cao 9Wu Wei Zi 6Xi Xin 9Gan Jiang 9LING GUI WU WEI GAN CAO TANGFu Ling 4 liang 12 gmGui Zhi 4 liang 12 gmGan Cao 3 liang 9 gmWu Wei Zi ½ sheng 6 gmComparisonTake out Gui zhi, add xi xin and gan jiang

This modification suggests that the original formula is being adjusted to address the specific symptoms of coughing and chest fullness, due to an underlying pattern of "surging Qi" that has been reduced by the original formula. Gan Jiang and Xi Xin are added to disperse cold and resolve phlegm, to treat the cough and chest fullness..This Formula takes out the Gui Zhi after the initial treatment of reducing the surging Qi.. Just as the Jin Gui says: “in phlegm fluid illness, one must warmly transform.”

Ling Gan Wu Wei Jiang Xin Tang•When there is coughing with chest fullness, this is a condition in which there are cold fluids hidden in the lungs. The treatment should warm the lungs and transform fluids while diminishing cough. This formula uses Fu Ling. On the one hand Fu Ling will lead and gather the fluids so they can be removed through the urination and on the other hand it will treat the source of the generation of fluids. This is why Fu Ling is the principal herb. The ministers are Gan Jiang and Xi Xin which warm the lung, scatter cold and transform fluids. In order to prevent the Gan Jiang and Xi Xin from squandering and scattering the lung Qi, Wu Wei Zi is added as an assistant. Wu Wei Zi will restrain the lung Qi and stop cough. Finally, there is Gan Cao which synchronizes and harmonizes all of the herbs. Altogether this formula scatters while restraining and opens while closing. This will cause the cold in the lungs to warm up and the phlegm to transform. The cough and fullness will then be cured.Ling Gan Wu Wei Jiang Xin TangFu Ling 12Gan Cao 9Wu Wei Zi 6Xi Xin 9Gan Jiang 9

ChiefDeputyGan Jiang• warms the lung and dissipates cold to dissolve rheum• warms and activates spleen yang to dissipate dampnessXi Xin warms the lung and dissipates coldFu LIng Fortifies the spleen and drains dampness dissolves rheum and promotes urinationAssistantWu Wei Zi• astringes the lung and relieves coughWhen combined with gan jiang and xi xin, these three work together to disperse the Rheum fluids without harming the Zheng qi and astringe the lung QiEnvoy Gan Cao• harmonizes the actions of all medicinals

Ling Gan Wu Wei Jiang Xin Tang•This formula is quite elegant in its composition. It can dispel Rheum with out the acridity of Ma huang and Gui zhi, dispel evil without damaging upright Qi, and is more moderate in action than Xiao Qing Long Tang. It is excellent as a base formula in the treatment of deficiency-type propping rheum patterns.•Both XQLT and LGWWJXT act to warm the lung and dispel rheum because they share the same medicinals and dosages of Gan Cao, Gan Jiang, Xi Xin and Wu Wei Zi. However Ling gan wu wei Jiang xin Tang is generally used for deficient patients with cold Rheum, so Fu Ling is added. XQLT treats patients who are not deficient with patterns of external cold and internal Rheum, so dispersing medicinals such as Ma Huang and Gui Zhi are included.•LGWWJXT can be used in the treatment of chronic coughing in bronchitis, emphysema, and asthma when associated with deficiency patterns of cold Rheum in the Lungs.Ling Gan Wu Wei Jiang Xin TangFu Ling 12Gan Cao 9Wu Wei Zi 6Xi Xin 9Gan Jiang 9

LGWWJXT compared to XQLTLing gan wu wei jiang xin tang Xiao Qing Long TangMa Huang 9Gui Zhi 9Bai Shao 9Gan Cao 6Gan Cao 9Wu Wei Zi 6Wu Wei Zi 6Xi Xin 9Xi Xin 9Gan Jiang 9Gan Jiang 9Gan cao 6Ban Xia 9Fu ling 12Gan Cao 9 cold -Phlegm in lungsPoor Processing of Cold on the surface with Rheum causing Allergic Cough and Asthma and upper fluid accumulation (eyes, nose) Floating pulse

• XQLT = focuses on exterior and regulates fluid metabolism by dispersing fluids to the exterior w/ Ma huang, Gui zhi with xi xin and Gan jiang, Tai Yang , Tai Yin• LGWWJXT = focuses on Lung cold phlegm/rheum and regulates fluid metabolism by warming the lung and promoting urination , Xi xin, Gan jiang with Fu ling, Tai yin• There is not an exterior pattern with LGWWJXT, patient will not feel like they are coming down with something or affected by allergies as in poor processing at the surface of the body. This pattern can show up after treating an exterior pattern.• Poor processing is when the body encounters something from outside, the symptom occurs( wind, heat, cold, phlegm as in sneezing due to pollen, or heat rash when exposed to the sun, the symptom goes away when not around as in seasonal allergies, etc.) sneezing with pollen exposure- p/p of wind in the nose• Heat rash with sun exposure- P/P of heat on the skin

Gan Cao Gan Jiang Tang• Gan Cao and Gan Jiang • Lung cold/frozen, fluids have become cold and congealed, lungs unable to descend and disseminate.• Frozen earth and metal, inside a lot of Rx’s

Diagnosis. Signs, symptoms and treatment Ling Gan Wu Wei Jiang Xin Tang• Cold Rheum in the Lungs, Lung Qi counterflow• .Cough• Sensation of cold in the chest• feeling of discomfort/heaviness in the chest and diaphragm• - wheezing (wet)- difficulty breathing- profuse salivation with inclination to spit• All with profuse sputum that is thin, watery, clear or white T = pale/flabby with moist white coat/slimy white coatP = slow slippery or deep wiry or Wiry and tight• Wiry is the main pulse for fluid illness• Treatment Principle: warm the lungs to disperse cold, transform phlegm/Rheum to alleviate symptoms of coughing and wheezing/ respiratory distress.

Western Diagnosis• Asthma• Bronchitis• COPD• Dyspnea• Cough• Edema• Pulmonary edema

Original text [Chapter 12.38]: After you have stopped the cough and fullness, if the thirst and surging Qi arise again, this due to the hot nature of Xi Xin and Gan Jiang. It is normal for there to be thirst when taking them. However, if the thirst stops, this means [the thirst was due to] propping rheum. Propping Rheum typically causes dizziness and this dizziness should cause vomiting. When there is vomiting add Zhi Ban Xia to eliminate water.(From chapter 12 of the Jin Gui Yao Lue chapter on the pulse, pattern and treatment of phlegm fluid coughing).Ling Gan Wu Wei Jiang Xin TangFu Ling 12Gan Cao 9Wu Wei Zi 6Xi Xin 9Gan Jiang 9Ban Xia 6Vomiting with DizzinessLing Gan Wu Wei Jiang Xin Xia Tang

Ling Gan Wu Wei Jiang Xin Xia Tang• Absence of thirst indicates that rheum accumulation has not been addressed effectively. Since LGWWJXT is warm in nature, if yang qi returns after taking this rx, the patient should become thirsty. However, when remaining rheum evils harass the stomach Qi, vomiting and dizziness appear. Ban xia is added to LGWWJXT.• This will warm the lung dispel rheum, check retching.

Ling Gan Wu Wei Jiang Xing Xia Xing TangOriginal Text [Chapter 12.39] After water has been eliminated and vomiting is checked, if the person displays generalized swelling, add Xing Ren. For this pattern, Ma Huang would normally be added but since the patient presents with impediment, it is not included. If one acts against the condition and adds this, it will cause reversal. The reasoning is that the person is blood deficient, and Ma Huang will act to diffuse the Yang. Ling Gan Wu Wei Jiang Xing TangFu Ling 12Gan Cao 9Wu Wei Zi 6Xi Xin 9Gan Jiang 9Ban Xia 9Xing Ren 9With Swelling with no blocked exterior

Original Text [Chapter 12. 40]: If the face is hot as if the person were drunk, this is stomach heat surging upward to smoke the face. In this case, add Da Huang to disinhibit.Ling Gan Wu Wei Jiang Xing Da Huang TangFu Ling 12Gan Cao 9Wu Wei Zi 6Xi Xin 9Gan Jiang 9Ban Xia 9Xing Ren 9Da Huang 9Blocked Yang Ming with Red FaceLing Gan Wu Wei Jiang Xing Xia Xing Da Huang Tang

Case- M, 48 slim build• Telemedicine patient for Covid, July 2022.• Patient is tall with thin body, vulnerable and soft spoken.• Aversion to wind, achy body, chills, slight headache, soaking the sheets at night with cold sweats last 3 Evenings, fatigued• When not sick: tends to cold body, low back weakness, leg weakness, both worse when tired, easy to sweat.• Patient has been struggling with long covid from 2 years ago( symptoms of fatigue, cold body( wears hats in the summer), • T- pale/swollenP- unavailable due to online consultationAbd- from prior treatments- empty low abdomen, tight rectus

Symptom analysis• Aversion to wind- open surface• Achy body- stasis on surface Tight rectus- blood xu • Chills- cold on surface empty below navel- kd def• Headache- stasis in head• Fatigue- Qi not available • Night sweating-sweat out too much at night• w/cold body- cold rel. sweating at nightGeneral symptoms• Sweats easy- sweat out too often• Cold body- cold Diagnosis 5:, wind- cold invasion, disharmony of ying and wei,• Weak low back- Kd involvement Kidney yang def• weak legs- def• w/w tired- def rel. low back/leg weakness Diagnosis in 6: Taiyang( Zhong feng, wind- strike), Shao yin T- pale- def RX: Gui zhi Jia Fu zi tangSwollen- dampness

Patient was given 3 days worth of Gui zhi Jia fu zi tang.Patient reported that his chills and achy body were gone after 2 doses and felt his energy come up. The cold sweats at night reduced and no longer felt cold, only slight sweat after last dose. The external symptoms of achy body, chills and headache had resolved. The following morning he noticed he was starting to cough. Coughing w/ abundant clear phlegm, it progressively became worse in the next couple days he was unable take a deep breath with a feeling he was drowning in mucous . Unable to sleep without sitting up, he would gag with the phlegm and cough all night if he was prone. Puffy around eyes, watery eyesT- swollen/ pale/wet, Pulse and abdomen not available.

Symptom analysis• Cough- lung reversal• Clear abundant phlegm- cold phlegm-rheum in lungs• Drowning in mucous- excess phlegm in lungs• Puffy eyes- water swelling around eyes• Watery eyes- water in eyes• T- wet coating- cold Rheum• T- swollen- damp• T- pale- def• congested fluids with Cold phlegm/Rheum in the Lungs. Lung qi reversal• Taiyin lung• warm the lungs to disperse cold, transform Phlegm- Rheum to relieve his lung distress

• Ling Gan Wu Wei Jiang Xin Tang in granules.• Fu ling 12• Gan cao 9• Wu wei zi 6• Xi xin 9• Gan jiang 9

Results• After one dose his cough greatly reduced and did not feel like he was gagging on mucous. • and after the 3rd dosage of herbs he was well and felt back to health, the cough and mucous completely cleared up, watery eyes and puffy around eyes resolved• Points to how cold patterns can be quickly resolved.• He is currently taking Shen Qi Wan to work on his underlying Kidney deficiency, His long covid symptoms are resolving.

Case: Cough, female 62• Patient is a warm 62 year old woman who is very heavy in her lower body, she looks exhausted and she is short of breath easy and was coughing during the consult• Patient has been diagnosed with COPD for past 4 years, chief complaint is a cough with clear abundant phlegm, lungs feel heavy , wheezing, SOB with talking and mild exercise• All lung symptoms worse with cold exposure, stays inside w/ cold weather. Sleeps with pillows to prop her up or she will cough all night. Uses inhalers daily.• weak low back, worse when tired• urination up 2x night, sometimes incomplete feeling and has to get up again 10 min later.• Puffy in lower body, tissues of legs feel puffy filled with water, pitting edema in ankles.• Mostly Cold lower body but whole body can get cold easy.• sweats easyT- pale blue hue/ swollen/ dip in root/ teeth marks• P- deep and thready/• Abd- lax abdomen

Symptom analysisCough- lung reversal Excess Cold-phlegm in lung rel. lung reversal , stasis in chest, SOB w/ abundant clear phlegm- cold phlegm in Lu w/w cold weather- cold rel w/ wheezing- lungs affected w/Heavy chest- stasis in chest w/SOB- lung affected w/w lie flat- excess in lungsWeak low back- Kd involvement Kd involvementIncomplete urination- damp in lower jiao Damp in lower jiaoPuffy legs- damp in tissues of legs Damp in tissues of legsCold body- cold coldPitting edema- kd yang def Kd yang xuSweats easy- sweat out too much Excess cold-phlegm in lungsT- pale- def Spleen qi xu T- blue- cold Dampness in tissues of legs /lower jiaoT- swollen- damp Kidney yang xuT- t marked- spleen qi xu Spleen qi xu Tai Yin, Shao YinDip in root- Kd def KD defAbd- lax- deficency

Zhen Wu tang/ Ling gan wu wei jiang xin Tang• Fu ling 12• Gan cao 6• Wu wei zi 9• Gan jiang 6 • Xi xin 6• Bai zhu 12• Bai shao 9 Fu zi 9

Classic modification of Zhen Wu TangIf there is a cough add wu wei zi, xi xin and Gan jiang. If urine is uninhibited remove Fu ling. If there is Diarrhea remove Bai shao and add Gan jiang. If there is retching remove Fu zi and add Sheng jiang.( most of the herbs are here in Ling Gan wu wei Jiang xin tang)

Results• Patient was treated with modifications of this Rx for a few weeks and is now doing well, less mucous and can tolerate going out on cold days if she is dressed well, energy is up and can sleep without being propped up, her pitting edema and leg swelling are better, urination more complete. She is working with her western MD and using less of her inhalers.• Sa’am acupuncture Tx: Rotation of suppl. Lg Intestine, Heart+ and Kidney +have been very helpful to warm and consolidate, also helping with the water in her tissues and urination.

Links for quoted articles• https://whitepineinstitute.org/5-important-jin-gui-yao-lue-formulas-for-cough-season/• https://go.gale.com/ps/i.do?id=GALE%7CA153900016&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=01438042&p=HRCA&sw=w&userGroupName=oregon_oweb&isGeoAuthType=true&aty=geo